Fully automated MRI-based convolutional neural network for noninvasive diagnosis of cirrhosis

Objectives: To develop and externally validate a fully automated diagnostic convolutional neural network (CNN) model for cirrhosis based on liver MRI and serum biomarkers.

Methods: This multicenter retrospective study included consecutive patients receiving pathological evaluation of liver fibrosis stage and contrast-enhanced liver MRI between March 2010 and January 2024. On the training dataset, an MRI-based CNN model was constructed for cirrhosis against pathology, and then a combined model was developed integrating the CNN model and serum biomarkers. On the testing datasets, the area under the receiver operating characteristic curve (AUC) was computed to compare the diagnostic performance of the combined model with that of aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), and radiologists. The influence of potential confounders on the diagnostic performance was evaluated by subgroup analyses.

Results: A total of 1315 patients (median age, 54 years; 1065 men; training, n = 840) were included, 855 (65%) with pathological cirrhosis. The CNN model was constructed on pre-contrast T1- and T2-weighted imaging, and the combined model was developed integrating the CNN model, age, and eight serum biomarkers. On the external testing dataset, the combined model achieved an AUC of 0.86, which outperformed FIB-4, APRI and two radiologists (AUC: 0.67 to 0.73, all p < 0.05). Subgroup analyses revealed comparable diagnostic performances of the combined model in patients with different sizes of focal liver lesions.

Conclusion: Based on pre-contrast T1- and T2-weighted imaging, age, and serum biomarkers, the combined model allowed diagnosis of cirrhosis with moderate accuracy, independent of the size of focal liver lesions.

Critical relevance statement: The fully automated convolutional neural network model utilizing pre-contrast MR imaging, age and serum biomarkers demonstrated moderate accuracy, outperforming FIB-4, APRI, and radiologists, independent of size of focal liver lesions, potentially facilitating noninvasive diagnosis of cirrhosis pending further validation.

Key points: This fully automated convolutional neural network (CNN) model, using pre-contrast MRI, age, and serum biomarkers, diagnoses cirrhosis. The CNN model demonstrated an external testing dataset AUC of 0.86, independent of the size of focal liver lesions. The CNN model outperformed aminotransferase-to-platelet ratio index, fibrosis-4 index, and radiologists, potentially facilitating noninvasive diagnosis of cirrhosis.